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Drug replacement therapy comes full circle with nicotine-for-cannabis study

In cannabis research, the phenomenon of drug replacement therapy has received much recent interest. Studies have shown that cannabis could be useful as an “exit drug“, helping individuals cut back on substances including but not limited to opioids, alcohol, and tobacco. There is some evidence to show that cannabis, particularly CBD, could be useful for smokers who are looking to kick the habit.

Despite the demonstrable safety of cannabis compared to the other substances listed and the growing body of research that supports the idea that cannabis can help with addiction to more harmful substances, some organizations avoid funding this kind of work based on the outdated principle that cannabis is, well, bad. The National Institute on Drug Abuse (NIDA) is one such organization.

The drug replacement discussion comes full circle in a recently published clinical trial it funded, which used nicotine as an alternative to cannabis—more specifically, as therapy for individuals suffering from symptoms of cannabis withdrawal. It might seem counterintuitive to fund a study into the efficacy of a substance with years’ worth of research to show that it is both dangerous and addictive, but NIDA’s work has always seemed to intentionally counter the narrative that cannabis can be a force of good.

The clinical trial, conducted by researchers at the Southern Illinois University (SIU), hypothesized that a low-dose nicotine patch (7 milligrams) would help to reduce the symptoms of withdrawal in individuals who had become dependent on cannabis (but who were not regular nicotine users).

Symptoms of cannabis withdrawal can include diminished appetite, changes in mood, irritability, difficulty sleeping, headaches, cravings, and loss of focus, and typically last for no more than a few weeks depending on the amount of cannabis being consumed prior to abstinence. This begs the question: would it be logical to prescribe something as addictive as nicotine to help with non-life-threatening symptoms that will likely go away after a week or two? At least the scientists acknowledge in their paper that the trial, “was not designed with the expectation that the methods we used would be used in normal clinical practice.”

A total of 127 participants were given placebo and nicotine patches while abstaining from cannabis, and a $300 incentive to keep them from consuming during the duration of the trial. On four occasions over a three-year period, they ceased cannabis use for 15 days and recorded their symptoms every 48 hours. Scientists measured what’s referred to as “negative affect” to determine whether nicotine could be helpful to reduce one’s withdrawal from cannabis and satiate cravings.

Unfortunately for NIDA, which spent more than USD $1 million on the trial, the highly addictive substance didn’t provide them with the results they had hypothesized. In fact, the data show that participants of the study who received the placebo patch were more successful in abstaining from cannabis and than those who received the nicotine patch. The study’s results found that, relative to the placebo patch, the nicotine patch did provide some novel relief from symptoms, but only on a day-to-day basis, and not over the entire course of the period of abstinence. At the same time, authors pointed out that some who used the nicotine patch experienced increased nausea, making them crave cannabis even more.

“The treatment's main effect across all points in time was not significant,” write the researchers in their conclusion.

Leave it to studies like this to remind to us to look into the motivation and the source of funding behind any and all academic research.

This article is available under a Canadian Creative Commons licence.